Systems and methods for adjacent vertebral fixation

ABSTRACT

The present invention relates to systems and methods for spinal fusion procedures that can allow all components of the spinal fusion procedure to be inserted into the wound of a patient at once, and can thus minimize the number of components that must be separately inserted into a wound. This can be accomplished by providing a intervertebral fixation system that allows an intervertebral cage, vertebral fixation plate, and drill guides to be assembled into a single unit prior to insertion into a patient.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims benefit, under 35 U.S.C. §119(e), to U.S.Provisional Application No. 62/343,483, filed 31 May 2016. The entirecontents and substance of the above application are hereby incorporatedby reference as if fully set forth herein.

TECHNICAL FIELD

The present disclosed technology is primarily applicable to adjacentvertebral fixation; however it is also applicable to the fields oforthopedic surgery and biotechnology, as would be recognized by a personof ordinary skill in the art.

BACKGROUND

In the field of adjacent vertebral fixation, temporary pins have manydisadvantages. If they are small, they do not hold the plate securely.If they are large, the same is often true but they also create cavitiesin the vertebral bodies. Additionally, it is preferable for the plate tobe flush with the vertebral bodies to prevent the plate from acting as alever and pulling out the pins when the plate is manipulated.

What is needed, therefore, is a vertebral fixation system that allowsfor adjacent vertebral fixation without the need to use temporary pins.Embodiments of the present invention address this need as well as otherneeds that will become apparent upon reading the description below inconjunction with the drawings.

BRIEF SUMMARY

Some embodiments of the present invention include a vertebralstabilization system comprising a positioning handle comprising a shaftwith a distal end and a proximal end, the distal end of the shaftcomprising a first locking mechanism, a cage-plate holder comprising ahandle channel, the handle channel having an inner diameterapproximately equal to the outer diameter of the positioning handle,such that a portion of the shaft can be inserted into the handlechannel, a drill guide assembly comprising an opening from proximal todistal end of the drill guide assembly, and wherein the opening of thedrill guide assembly is configured to accept a drill, a vertebralstabilization plate comprising a handle hole and an opening, wherein aninner diameter of the handle hole is approximately equal to the outerdiameter of the distal end of the shaft of the positioning handle, suchthat distal end of the shaft of the positioning handle can be insertedinto the handle hole, and wherein the opening of the plate issubstantially aligned with the placement of the opening of the drillguide assembly, and an intervertebral cage comprising a distal end, aproximal end, and an opening, wherein the proximal end comprises anorifice with a second locking mechanism configured to lock with thefirst locking mechanism of the distal end of the shaft of thepositioning handle, and wherein the opening of the cage extends from thesuperior side of the cage to the inferior side of the cage.

In some embodiments, the positioning handle further comprises a fluidchannel extending from the proximal to distal end of the positioninghandle. In some embodiments, the proximal end of the shaft of thepositioning handle further comprises a syringe receptacle. In someembodiments, the proximal end of the shaft further comprises a feedramp. In some embodiments, the first locking mechanism of the shaft ofthe positioning handle comprises external screw threads, and wherein thesecond locking mechanism of the orifice of the cage comprises internalscrew threads. In some embodiments, the first locking mechanism of theshaft of the positioning handle comprises a keyway, wherein the secondlocking mechanism of the orifice of the cage comprises a keyhole, andwherein the keyway is configured to lock in the keyhole. In someembodiments, the cage-plate holder comprises a handle. In someembodiments, the cage-plate holder further comprises said drill guideassembly. In some embodiments, the cage-plate holder further comprises athird interlocking mechanism, and the drill guide assembly furthercomprises a fourth interlocking mechanism, the third and fourthinterlocking mechanisms configured to interlock with one another

The present invention further includes a method for stabilizing avertebral column comprising inserting a positioning handle through ahandle channel of a cage-plate holder, the positioning handle comprisinga shaft with a distal end and a proximal end, the distal end of theshaft comprising a first locking mechanism, attaching a drill guideassembly to the cage-plate holder, the drill guide assembly comprisingan opening from proximal to distal end of the drill guide assembly, andwherein the opening of the drill guide assembly is configured to accepta drill, inserting the positioning handle into a vertebral stabilizationplate, the plate comprising a handle hole and an opening, wherein aninner diameter of the handle hole is approximately equal to the outerdiameter of the distal end of the shaft of the positioning handle, suchthat distal end of the shaft of the positioning handle can be insertedinto the handle hole, and wherein the opening of the positioning handleis substantially aligned with the placement of the opening of the drillguide assembly, and interlocking the first locking mechanism of thedistal end of the shaft with a second locking mechanism of anintervertebral cage, the cage comprising a distal end, a proximal end,and an opening, wherein the proximal end of the cage comprises anorifice with the second locking mechanism configured to lock with thefirst locking mechanism of the distal end of the shaft, and wherein theopening of the cage extends from the superior side of the cage to theinferior side of the cage, inserting the intervertebral cage into theintervertebral space of a patient, and inserting a screw through theopening of the drill guide assembly.

In some embodiments, the cage-plate holder comprises said drill guideassembly. In some embodiments, the drill guide assembly comprises aplurality of openings, wherein the intervertebral stabilization platecomprises a plurality of openings, wherein the openings of the plate arealigned with the location of the openings of the drill guide assembly,and wherein a screw is inserted into an opening of the drill guideassembly and into an opening of the plate. In some embodiments, thefirst locking mechanism of the shaft of the positioning handle comprisesexternal screw threads, and wherein the second locking mechanism of theorifice of the cage comprises internal screw threads. In someembodiments, the first locking mechanism of the shaft comprises externalscrew threads, wherein the handle hole of the vertebral stabilizationplate comprises internal screw threads, wherein the second lockingmechanism of the intervertebral comprises internal screw threads,wherein the first locking mechanism of the shaft is threaded into thehandle hole of the plate, and wherein the first locking mechanism of theshaft positioning handle is threaded into the second locking mechanismof the cage. In some embodiments, the first locking mechanism of theshaft of the positioning handle comprises a keyway, wherein the secondlocking mechanism of the orifice of the cage comprises a keyhole, andwherein the keyway is configured to lock in the keyhole.

Some embodiments further comprise disposing a material within theopening of the cage prior to disposing the cage into the patient. Someembodiments further comprise removing the first locking mechanism of theshaft from the orifice of the cage, inserting a syringe into the orificeof the cage, wherein the orifice of the cage extends into the opening ofthe cage, delivering fluid into the orifice of the cage and into theopening of the cage. In some embodiments, the positioning handle furthercomprises a fluid channel extending from the proximal end of the shaftto the distal end of the shaft, wherein the orifice of the cage extendsinto the opening of the cage, and wherein the proximal end of the shaftcomprises a syringe receptacle configured to accept a syringe. Someembodiments further comprise inserting a syringe into the syringereceptacle of the shaft, and delivering fluid through the positioninghandle, through the orifice of the cage, and into the opening of thecage. Some embodiments further comprise disposing a material within theopening of the cage prior to disposing the cage into the patient,inserting a syringe into the syringe receptacle of the shaft, anddelivering fluid through the positioning handle, through the orifice ofthe cage, and into the opening of the cage. In some embodiments, theproximal end of the shaft further comprises a feed ramp.

The foregoing summarizes only a few aspects of the present invention andis not intended to be reflective of the full scope of the presentinvention. Additional features and advantages of the present inventionare set forth in the following detailed description and drawings, may beapparent from the detailed description and drawings, or may be learnedby practicing the present invention. Moreover, both the foregoingsummary and following detailed description are exemplary and explanatoryand are intended to provide further explanation of the presentlydisclosed invention as claimed.

BRIEF DESCRIPTION OF THE FIGURES

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate multiple embodiments of thepresently disclosed subject matter and serve to explain the principlesof the presently disclosed subject matter. The drawings are not intendedto limit the scope of the presently disclosed subject matter in anymanner.

FIG. 1 is an exploded view of a modular vertebral fixation apparatus inaccordance with an embodiment.

FIGS. 2A-D are various views of an intervertebral cage in accordancewith an embodiment.

FIGS. 3A-B show a four-screw vertebral fixation plate with a centerhole, in accordance with an embodiment.

FIGS. 4A-B show a two-screw vertebral fixation plate with a center hole,in accordance with an embodiment,

FIGS. 5A-B show a threaded handle in accordance with an embodiment, inaccordance with an embodiment.

FIGS. 6A-6B show a threaded handle with a central channel in accordancewith an embodiment.

FIG. 6C is a detailed view of the threaded end of a threaded handle witha central channel, in accordance with an embodiment.

FIG. 6D is a detailed view of a syringe receptacle of a threaded handlewith a central channel in accordance with an embodiment.

FIGS. 7A-7B depict an embodiment where a fluid substance can beintroduced into the cavity in the intervertebral cage using a syringeinserted through an injection cap.

FIGS. 8A-8C depict a cage fastener plug in accordance with anembodiment.

FIGS. 9A-9C depict a shearable cage fastener plug in accordance with anembodiment.

FIGS. 10A-10C depict a combination injection cap and shearable cagefastener plug in accordance with an embodiment.

FIG. 11 depicts a cage plate holder in accordance with an embodiment.

FIG. 12 depicts a cage plate holder in accordance with an embodimentwith four screws are installed through the cage plate holder and intothe intervertebral fixation plate.

FIG. 13A is a cutaway view of a cage plate holder showing the drillguide channels within the drill guide assembly.

FIG. 13B is a cutaway view of a cage plate holder showing the centralchannel passing through the length of the cage plate holder and drillguide assembly.

FIG. 14 is a view of an assembled modular intervertebral fixation devicein accordance with an embodiment.

FIG. 15 is a cutaway view of an assembled modular intervertebralfixation device in accordance with an embodiment.

FIG. 16A depicts the insertion of the modular intervertebral fixationdevice into an intervertebral space.

FIG. 16B depicts drilling holes in the vertebrae adjacent to theintervertebral space the modular intevertebral fixation device isinserted into using the drill guide assembly of the cage plate holder.

FIG. 16C depicts inserting screws into the vertebrae adjacent to theintervertebral space the modular intevertebral fixation device isinserted into using the drill guide assembly of the cage plate holder.

FIG. 16D depicts the resulting installed intervertebral fixation plateand interbody cage.

FIG. 17 depicts an embodiment of the cage plate holder and theintervertebral fixation plate with an interlocking feature.

FIG. 18 depicts an embodiment of the intervertebral fixation system inaccordance with an embodiment, including a detachable handle anddetachable drill guide assembly.

FIG. 19 depicts further details of the embodiment shown in FIG. 18.

FIG. 20 depicts an assembled intervertebral fixation system inaccordance with the embodiment depicted in FIG. 18.

FIG. 21 depicts a rear view of an installed cage, vertebral fixationplate, and screws.

FIG. 22 depicts a side-view of the installed cage, vertebral fixationplate, and screws of FIG. 21.

FIG. 23 depicts a method for using a vertebral fixation system inaccordance with an embodiment.

DETAILED DESCRIPTION

Although example embodiments of the disclosed technology are explainedin detail, it is to be understood that other embodiments arecontemplated. Accordingly, it is not intended that the invention islimited in its scope to the details of construction and arrangement ofcomponents set forth in the following description or illustrated in thedrawings. The invention is capable of other embodiments and of beingpracticed or carried out in various ways. Also, in describing thepreferred embodiments, specific terminology will be resorted to for thesake of clarity.

It should also be noted that, as used in the specification and theappended claims, the singular forms “a,” “an” and “the” include pluralreferences unless the context clearly dictates otherwise. References toa composition containing “a” constituent is intended to include otherconstituents in addition to the one named.

Also, in describing the preferred embodiments, terminology will beresorted to for the sake of clarity. It is intended that each termcontemplates its broadest meaning as understood by those skilled in theart and includes all technical equivalents which operate in a similarmanner to accomplish a similar purpose.

Ranges may be expressed herein as from “about” or “approximately” or“substantially” one particular value and/or to “about” or“approximately” or “substantially” another particular value. When such arange is expressed, other exemplary embodiments include from the oneparticular value and/or to the other particular value.

Herein, the use of terms such as “having,” “has,” “including,” or“includes” are open-ended and are intended to have the same meaning asterms such as “comprising” or “comprises” and not preclude the presenceof other structure, material, or acts. Similarly, though the use ofterms such as “can” or “may” are intended to be open-ended and toreflect that structure, material, or acts are not necessary, the failureto use such terms is not intended to reflect that structure, material,or acts are essential. To the extent that structure, material, or actsare presently considered to be essential, they are identified as such.

It is also to be understood that the mention of one or more method stepsdoes not preclude the presence of additional method steps or interveningmethod steps between those steps expressly identified. Moreover,although the term “step” may be used herein to connote different aspectsof methods employed, the term should not be interpreted as implying anyparticular order among or between various steps herein disclosed unlessand except when the order of individual steps is explicitly required.

The components described hereinafter as making up various elements ofthe invention are intended to be illustrative and not restrictive. Manysuitable components that would perform the same or similar functions asthe components described herein are intended to be embraced within thescope of the invention. Such other components not described herein caninclude, but are not limited to, for example, similar components thatare developed after development of the presently disclosed subjectmatter.

To facilitate an understanding of the principles and features of theinvention, various illustrative embodiments are explained below. Inparticular, the presently disclosed subject matter is described in thecontext of a spinal fusion procedure. The present invention, however, isnot so limited, and can be applicable in other contexts. Accordingly,when the present invention is described in the context of spinal fusion,it will be understood that other embodiments can take the place of thosereferred to.

The present disclosed technology includes a vertebral fixation systemthat can comprise a number of components that can be temporarilyassembled to aid in the performance of a vertebral fixation procedure.In some embodiments, the vertebral fixation system can comprise acage-plate holder, interbody cage (“cage”), vertebral fixation plate,drill guide assembly, and threaded handle. Prior to a procedure, asurgeon can assemble the vertebral fixation system into a singleintegrated unit by passing the threaded handle through the cage plateholder, and screwing on the vertebral fixation plate and cage.

Once assembled, and once a space has been made in an intervertebralspace for insertion of the device, the cage can be inserted into anintervertebral space. Because the drill guide assembly and vertebralfixation plate are connected to the cage, the cage can maintain thealignment of vertebral fixation plate and drill guide assembly with theadjacent vertebrae. Because the cage provides this alignment function,temporary fixation pins need not be used to maintain alignment of thefixation plate and drill guide assembly.

In some embodiments, once holes are drilled in the adjacent vertebrae,bone screws can be inserted through the drill guide assembly andtightened into the drilled holes without the need to extract the drillguide assembly. Once the vertebral fixation plate is affixed to theadjacent vertebrae, the threaded handle can be un-screwed, and the cageplate holder removed. Once removed, the cage remains in anintervertebral space, and the vertebral fixation plate remains affixedto the adjacent vertebrae.

In some embodiments, an orifice in the cage, previously used to attachthe cage to the cage plate holder, can be used to introduce a fluidsubstance, such as a bone growth promoter, into the intervertebralspace. In some embodiments, an inactive, solid biologic material can bedisposed in the central cavity of the cage, and inserted into a patient.After insertion, a fluid substance that activates the solid bone growthpromoting material can be delivered through the orifice in the cage toactive the inactive biologic material. In either case, the cage canserve to confine the fluid substance to the intervertebral space, andprevent contamination of adjacent anatomical features with the fluidsubstance. This fluid substance can be introduced in a variety of ways,as described below. In some embodiments, the fluid substance can bedelivered through a threaded handle screwed into the orifice in the cagewhile the vertebral fixation system is still assembled. In someembodiments, the fluid substance can be delivered through the orificeafter the removal of the cage plate holder.

FIG. 1 depicts the components of a vertebral fixation system inaccordance with an embodiment. The fixation system can include amulti-screw vertebral fixation plate, such as a two-screw vertebralfixation plate 400 or a four-screw vertebral fixation plate 300, a cage200, and one or more bone screws 101. The vertebral fixation system canbe used to perform a spinal fusion procedure by inserting a cage 200filled with a bone growth factor or active biologic agent into theintervertebral space of a patient, and affixing the vertebra above andbelow the cage using a vertebral fixation plate 300/400. To perform sucha procedure, a surgeon can affix a cage 200 and a vertebral fixationplate 300/400 to a cage-plate holder 1100 using a threaded handle 500.The threaded handle can be inserted through a handle channel 1101 of thecage-plate holder 1100.

FIG. 2A-2D are views of an intervertebral cage 200 in accordance with anexample embodiment. Cage 200 forms an enclosure, such as anapproximately a square shape, with a cavity 201 in the center. In someembodiments, the outer edges of the cage 200 are rounded. In someembodiments, the inner surfaces of the cavity 201 are also rounded. Insome embodiments, the distal end of the cage 202—furthest from thesurgeon—can be narrower than the proximal end 203. In this case, thecage would form a trapezoid with the distal end 202 being the shortestedge. In some embodiments, Cage 200 can have a textured upper 204 andlower 205 surfaces to encourage bone growth and fixation of the cagewhen inserted in a patient. In some embodiments, Cage 200 can have atapered or wedge shape, such that the distal end 202 is slightly smallerthan the proximate end 203, as shown in FIG. 2C. Cage 200 further has anorifice, or channel 206 in the proximal end of the cage. This orificepasses from the outer edge of proximal end 203 to cavity 201. In someembodiments, this orifice has threads on its inner surface, allowing thethreaded end of threaded handle 500 to screw into Cage 200. Cage 200 canbe made of materials such as titanium or Polyether ether ketone (PEEK),or can comprise bone allografts.

FIGS. 3A-3B depicts a four-screw vertebral fixation plate 300 inaccordance with an embodiment. The vertebral fixation plate has a hole301 through which a threaded handle 500 can be inserted. In someembodiments, the surface of hole 301 can be threaded. In someembodiments, the surface of hole 301 is not threaded. The vertebralfixation plate of an example embodiment has four screw holes 302. Eachof these screw holes can be counter-sunk to match the head of a bonescrew 101. In some embodiments, screw hole 302 is approximately the samesize as the screw, fully constraining the position of the vertebralfixation plate 300 relative to the bone screw 101. In some embodiments,screw hole 302 can be elongate or semi-constrained, allowing the screwto move relative to the vertebral fixation plate when attached to avertebra. The vertebral fixation plate can be used with anintervertebral cage 200.

FIGS. 4A-4B depict a two-screw vertebral fixation plate 400 inaccordance with an embodiment. The two-screw vertebral fixation plate400 can have substantially the same features as the four-screw vertebralfixation plate 402, except it only has two screw holes 301.Alternatively, the fixation plate may have another suitable number ofscrew holes.

FIGS. 5A-5B depict threaded handle 500. In some embodiments, threadedhandle 500 is used to connect the cage 200 to the cage plate holder1100, vertebral fixation plate 300 or 400, and cage 200. Threaded handle500 can have a threaded end 501 which can screw into orifice 206 of cage200. The threaded end 501 can be substantially as long as the depth ofthe threaded orifice 206 in cage 200. In some embodiments, the threadedend 501 can be substantially as long as the sum of the thickness of thethreaded orifice 206 in cage 200, and the thickness of hole 301 in thevertebral fixation plate 300 or 400, particularly when hole 301 isthreaded. In some embodiments, the threaded handle 500 may have analternative attachment mechanism for attachment to the cage 200 and/orvertebral fixation plate 300 or 400. For example, the threaded handle500 may have a keyway that interlocks with a keyhole in the cage 200 orvertebral fixation plate 300 or 400. Other attachment mechanismssuitable for connecting threaded handle 500 to cage 200 or vertebralfixation plate 300 or 400 would be readily recognized by persons havingordinary skill in the art. Threaded handle 500 also has a shaft 502which can extend through the cage plate holder 1100, and through thevertebral fixation plate 300 or 400. The diameter of shaft 502 can beapproximately the interior diameter of the hole in the vertebralfixation plate 300 or 400, or the interior diameter of the centralchannel 1101 in cage plate holder 1100. When inserted into cage plateholder 1100, the threaded handle 500 should be able to slide within thecentral channel 1101 in cage plate holder 1100 with minimal play withinthe channel. In some embodiments, threaded handle 500 can have a handle503, which allows the threaded handle to be manipulated by a surgeon.Handle 503 can also allow the entire assembled modular vertebralfixation system 100 to be manipulated by the surgeon. Threaded handle500 can also have an impact surface 504 that allows the modularvertebral fixation system to be struck with a mallet to insert the cageinto an intervertebral space.

FIG. 6A-6B depict a threaded handle with a fluid channel 600 for usewith an injectable substance. Like the first threaded handle 500, thethreaded handle has a threaded end 601, a shaft 602, and a handle 603.In addition, the threaded handle with a fluid channel 600 can have acentral fluid channel 604, and a syringe receptacle 605, as shown inFIG. 6B. The threaded end 601 is shown in more detail in FIG. 6C. Thethreaded end 601 is sized to screw into the orifice 206 of cage 200 andcreate a fluid-tight seal. To further facilitate the injection of afluid substance into the cavity 201 of cage 200, the inside diameter oforifice 206 of cage 200 can be made smaller than the inside diameter ofthe center hole 301 of vertebral fixation plate 300. The shaft 602 ofthreaded handle 600 can then include a segment near the end where theoutside diameter of the shaft changes from the smaller diameter matchingthe diameter of orifice 206 to a larger diameter that can fit throughcenter hole 301 of vertebral fixation plate 300. In this way, whenthreaded handle 600 is inserted into the cage, it will not penetrate thecage any further than the length of the portion of shaft 602 which issmaller than the inside diameter of orifice 206.

The syringe receptacle 605 is disposed in the handle 603, and isdesigned to mate with a syringe containing a fluid substance. In someembodiments, the syringe receptacle 605 can be threaded, allowing asyringe to be screwed into the syringe receptacle 605. In someembodiments, the syringe receptacle can be smooth, and shaped to allow asyringe to be press-fit into the receptacle. A feed ramp 606 canfacilitate the formation of a fluid-tight seal between the syringereceptacle 605 and the syringe. In some embodiments, the threaded handlewith a fluid channel 600 can be made of stainless steel, or othersuitable materials as would be recognized by one of skill in the art.

With these features, the threaded channel 600 can be used to inject afluid substance into the cavity 201 of cage 200. For example, in someembodiments, the cage may be inserted into an intervertebral space of apatient with the cavity 201 empty, or with an inactive biologicalmaterial. Once a surgeon has placed the cage 200, and affixed avertebral fixation plate 300/400 with bone screws 101, a fluid substancecan be introduced into the cavity 201. In some embodiments, the fluidsubstance can be a bone growth promoting biologic material, such asInfuse®. In some embodiments, the fluid substance can be an activationagent that activates the inactive biological material in cavity 201.

In some embodiments, the threaded handle with a fluid channel 600 can beused instead of a threaded handle without a fluid channel 500. In someembodiments, a protective cap can be placed over the syringe receptacle605 to protect it from impaction. In some embodiments, a threaded handlewithout a fluid channel 500 may be replaced during the procedure by thethreaded handle with a fluid channel 600 to allow a fluid to be injectedinto cavity 201.

FIGS. 7A-7B depict an embodiment where a fluid substance is introducedinto cavity 201 via a separate syringe 701. The syringe 201 can be usedafter the cage plate holder 1100 and threaded handle 500 have beenremoved, but while the wound in the patient is still open. The syringe701 can have a thin tip 702 for injecting through an injection cap 703.The injection cap can have a threaded or non threaded distal end 704which fits through orifice 206 in cage 200. The injection cap can besized such that it is snug enough and extends into the cage sufficientlyto insure a fluid tight seal. FIG. 7B depicts the insertion of thin tip702 of syringe 701 through injection cap 703 such that the thin tip 702is in fluid communication with the cavity 201 in cage 200.

FIGS. 8A-C depict a cage fastener plug 801 in accordance with anembodiment. Once a fluid substance has been introduced into cavity 201of cage 200, orifice 206 is still open, and can allow the fluidsubstance to leak out. FIG. 8A depicts the openings in the vertebralfixation plate 300 and cage 200 that lead to cavity 201. To seal theseopenings, an optional cage fastener plug 801 can be screwed into theorifice 206 of cage 200 to seal the cavity 201 of the cage 200, andretain the fluid substance, in some embodiments. This cage fastener plug801 can have a threaded surface 802 which mates with a threaded insidesurface of orifice 206 and also with threads on the inside of opening301 in the vertebral fixation plate 300, as shown in FIG. 8B. Wheninstalled, the cage fastener plug creates a fluid tight seal withorifice 206, sealing cavity 201, and having a top surface that is flushwith the upper surface of the vertebral fixation plate 300.

FIGS. 9A-9C depict an alternative shearable cage fastener plug 900 inaccordance with an embodiment. Like the previous cage fastener plug,shearable cage fastener plug 900 can be screwed into the orifice 206 ofcage 200 to seal the cavity 201 of the cage 200, and retain the fluidsubstance, in some embodiments. This shearable cage fastener plug 900can have a threaded surface 901 which mates with a threaded insidesurface of orifice 206 and also with threads on the inside of opening301 in the vertebral fixation plate 300, as shown in FIG. 9A. Wheninstalled, the shearable cage fastener plug creates a fluid tight sealwith orifice 206, sealing cavity 201, as shown in FIG. 9B. The shearablecage fastener plug 900 has a larger head 902 which can allow for easiermanipulation of the screw, and easier installation in the cage within apatient. The shearable cage fastener plug also has a shearable zone 903which breaks when a shearing force is applied to head 902, as shown inFIG. 9C.

FIGS. 10A-10C depict a combination injection cap and shearable cagefastener plug 1000. This combination fastener plug has a re-sealingopening 1001 which allows the thin tip 1002 of a syringe 1003 to passthrough the combination fastener plug 1000 such that it is in fluidcommunication with cavity 206. Additionally, it has a larger head 1004than the opening in vertebral fixation plate 300, and a shearing zone1005. To use the combination fastener plug, the plug is first screwedinto the vertebral fixation plate 300 and cage 200, as shown in FIG.10A. Then, the thin tip 1002 of syringe 1003 is inserted through theinjection cap 1000, allowing a fluid substance to be deposited in cavity206, as shown in FIG. 10B. Finally, the head 1004 is sheared from thebody of the combination fastener plug 1006, leaving a surface flush withthe vertebral fixation plate 300.

Cage fasteners may be made of a similar material to that of the cage200, such as titanium or PEEK. The fastener should be made of a materialthat does not create galvanic corrosion or produce free ions within thepatent. In some embodiments, the orifice 206 of cage 200 is counter-sunksuch that when installed, the outer surface of the fastener lies flushagainst the proximal surface 203 of cage 200. Further, the fastener plugshould be designed such that it is prevented from touching the vertebralfixation plate 300 to prevent galling or particulate creation betweenthe two if they abrade against each other.

FIGS. 11-12 depict a cage plate holder 1100 in accordance with anembodiment. Cage plate holder 1100 comprises a central channel 1101,drill guide assembly 1102, and handle 1103. The central channel is sizedto accommodate the threaded handle 500 or 600. The handle 1103 can beany handle allowing a surgeon to manipulate the cage plate holder 1100and is not entirely shown. Drill guide assembly 1102 allows a drill tobe passed through, and holes to be drilled in vertebrae adjacent to theintervertebral space of a patient to be treated to allow the vertebralfixation plate 400 or 300 to be affixed to them via bone screws 101. Insome embodiments, the drill guide assembly 1102 is welded or otherwisepermanently attached to the central channel 1101. In some embodiments,the drill guide assembly 1102 can be snap-fit to the central channel1101. Snap-fit drill guide assemblies can allow drill guides withvarying screw angles or screw configurations to be quickly interchanged,and can minimize the footprint of the components in the surgical tray.The drill guide assembly has openings 1104 that allow a drill bit to beplaced through the openings and exit the other side. In someembodiments, openings 1104 can be sized to allow for the use of awls,drills, and screws. In some embodiments, the openings 1104 will allow asurgeon to drill holes at varying angles with respect to the patient'sdorsal direction, such as between 0-30 degrees, for example. In someembodiments, the openings 1104 will guide drills and screws in apredetermined, fixed angle. The openings are also sized such that bonescrews 101 can be inserted through openings 1104 and installed in avertebral fixation plate 101/300. FIG. 12 depicts a cage plate holder1100 where used with a four-screw vertebral fixation plate 300. Thisfigured depicts that screws may be inserted through openings 1104 andthrough vertebral fixation plate 300 to attach the vertebral fixationplate 300 to the vertebrae adjacent to the intervertebral space wherethe cage 200 is inserted.

FIG. 13 is a cutaway drawing of cage plate holder 1100 through a planebisecting one of the openings 1104. The openings 1104 in drill guideassembly 1102 are formed in the shape of two intersecting cylinders1106, 1107. As would be understood by a person of ordinary skill, otherdrill guides can be made in accordance with embodiments wherein morethan four, three, or fewer than two cylinders are placed in drill guideassembly 1102, resulting in one or more openings 1104. So long as theopenings 1104 in the drill guide allow a drill bit to pass through theopening 1104 and be constrained to a cylinder 1106/1107 allowing foralignment of the cylinder 1106/1107 with a hole in a vertebral fixationplate 311, the drill guide assembly will operate in accordance with theinvention.

FIG. 14 is a cutaway drawing of a cage plate holder 1100 through a planebisecting the central channel 1101. The central channel 1101 passesthrough the entire length of cage plate holder 1100, allowing a threadedpin 500 to be passed through the central channel 1101. Likewise, thedistal openings of cylinders 1107 and 1106 in drill guide assembly 1102are visible.

FIG. 14 depicts an assembled modular vertebral fixation device 100 inaccordance with an embodiment. The fixation device 100 can be assembledby (1) inserting threaded handle 500 through the central channel 1101 ofcage plate holder 1100, (2) placing a vertebral fixation plate 300 onthe exposed end of threaded handle 500, and (3) attaching a cage byscrewing the threaded end 501 of the threaded handle 500 into theorifice 206 of cage 200. The result is an assembled vertebral fixationdevice 100 that can be placed into an intervertebral space of a patientand affixed with minimal need for additional fixation pins or alignmentdevices.

FIG. 152 depicts a cutaway of assembled modular vertebral fixationdevice 100 through a plane bisecting threaded handle 500. This viewshows threaded handle 500 passing through the cage plate holder 1100,through the vertebral fixation plate 300, and attaching to cage 200.

FIGS. 16A-D illustrate the steps for installing an embodiment of thepresent invention in an intervertebral space of a patient. FIG. 16Ashows an assembled vertebral fixation device inserted in anintervertebral space between vertebrae 1601 and 1602. Insertion can befacilitated by striking the impaction surface 504 of threaded handle500. The cage 200 functions as a very secure temporary pin. Thevertebral fixation plate 300 is not going to move or rotate as the holesare made and the screws placed. This can eliminate the need fortemporary pins.

FIG. 16B depicts drilling a hole in vertebra 1601 by passing a drill bit1603 into an opening 1104 and through cylinder 1107 of drill guideassembly 1102, and into vertebrae 1601. This process can be repeated anumber of times for each bone screw 101 that will be inserted intofixation plate 300.

FIG. 16C depicts the installation of bone screws 101 into vertebralfixation plate 300. The bone screws 101 can be installed in fixationplate 300 by passing the screws through the opening 1104 in drill guide1102. In some embodiments, this step can be performed with the modularvertebral fixation device 100 still fully-assembled.

FIG. 16D depicts the completed intervertebral fixation in a patient,with cage 200 disposed in the intervertebral space between vertebrae1601 and 1602, and vertebral fixation plate 300 affixed to the vertebraevia bone screws 101. Following the insertion of the bone screws 200, thethreaded handle 500 can be unscrewed from the cage 200, separating thecage plate holder 1100 and threaded handle 500 from the vertebralfixation plate 300 and cage 200. Once unscrewed, the threaded handle 500and cage plate holder 300 can be removed from the patient, leaving thevertebral fixation plate 300 affixed to the patients vertebrae 1601 and1602, and holding the cage 200 in position.

FIG. 17 depicts an embodiment of the drill guide assembly 1102 of cageplate holder 1100, and a vertebral fixation plate 300. In thisembodiment, the central channel 1101 passes through the drill guideassembly 1102, and has an interlocking feature 1701 Likewise, thevertebral fixation plate 300 has a corresponding interlocking feature1702 which can interlock with the interlocking feature of drill guideassembly 1102. FIG. 17 depicts a specific embodiment where theinterlocking feature is a rounded surface that mates with acorresponding rounded surface 1702 in vertebral fixation plate 300.

In some embodiments, the interlocking features of the cage plate holderand cage of the can be a rounded or chamfered surface, screw threads, ora snap-fit joint, or any other interlocking device as would becontemplated by a person having ordinary skill in the art. Theseinterlocking features 1701 and 1702 can prevent misalignment of thevertebral fixation plate and the drill guides due to a loosening of thethreaded rod 500 from the cage 200, or any unwanted play in theinterface between the vertebral fixation plate 300 and the drill guide1102. While the depicted interlocking rounded surface provides alignmentin two axes of the drill guide with the vertebral fixation plate, otherinterlocking devices that can provide alignment in three axes are alsocontemplated. For example, interlocking feature 1701 or 1702 can have akey way that matches with a flat or other feature of the correspondinginterlocking feature. Alternatively, one interlocking feature may beshaped like a gear, or any other shape, and the opposite interlockingfeature can be a depression with a corresponding shape.

FIG. 18 depicts the components of a vertebral fixation system inaccordance with an embodiment. The fixation system can include amulti-screw vertebral fixation plate 1801, a cage 1802, and one or morebone screws 1803. The vertebral fixation system can be used to perform aspinal fusion procedure by inserting a cage 1802 filled with a bonegrowth factor or active biologic agent into the intervertebral space ofa patient, and affixing the vertebra above and below the cage using avertebral fixation plate 1801. To perform such a procedure, a surgeoncan affix a cage 1802 and a vertebral fixation plate 1801 to acage-plate holder 1804 using a threaded handle 1805. In someembodiments, the drill guide assembly 1806 can be detached from thecage-plate holder 1804. This functionality enables the same cage-plateholder 1804 to be used with a variety of drill guide assemblies 1806that may be designed to provide appropriate drilling locations for acage 1802, vertebral fixation plate 1801, or for a particular patient'sanatomical structure or surgical location, among other reasons.

Additionally, the cage plate holder 1804 may further comprise adetachable handle 1807. By providing a detachable handle 1807, a varietyof handles 1807 can be used with cage plate holder 1804. Alternatively,the detachable aspect of detachable handle 1807 can allow the cage plateholder 1803 and handle 1807 to be stored in a smaller space.

FIG. 19 is a detailed view of the embodiment of FIG. 18. The cage plateholder 1804 can further comprise a peg 1901 which can be inserted into acorresponding slot 1902 of the drill guide assembly 1806. As shown,there are two pegs 1901 and two slots 1902; however, as would beunderstood by a person of ordinary skill in the art, a single peg 1901and a single slot 1902 can be used. Alternatively cage plate holder 1804and drill guide assembly 1806 can be connected in a variety of ways,including providing corresponding internal and external screw threads onthe distal end of the cage plate holder 1804 and the proximal end of thedrill guide assembly 1806. Alternatively, a corresponding keyway and keycan be used to interlock cage plate holder 1804 and drill guide assembly1806. Further, any mechanism that attaches the cage plate holder 1804 tothe drill guide assembly 1806 can be used, so long as the mechanismfixes the spatial relationship between the cage plate holder 1804 andthe drill guide assembly 1806.

FIG. 20 depicts the details of an assembled cage plate holder 1804,drill guide assembly 1806, vertebral fixation plate 1801, and cage 1802.The cage plate holder 1804 is affixed to the cage 1802 by the threadedhandle 1805. The drill guide assembly 1806 is affixed to the cage plateholder 1804 by the insertion of tab 1901 into slot 1902. In someembodiments, the drill guide can comprise one or more flanges 2001 whichlimit the rotational motion of the vertebral fixation plate 1801. Aswould be recognized by a person of ordinary skill in the art, anyfeature, including flanges, can be used to prevent the vertebralfixation plate 1801 from rotating with respect to the drill guideassembly 1806. These features further can ensure that the openings 2002of the drill guide assembly 1806 remain in alignment with the openings2003 of the vertebral fixation plate to allow screws 1803 and othertools to pass through the opening of the drill guide assembly 2002 andvertebral fixation plate 2003.

FIGS. 21 and 22 depict a vertebral fixation plate 1801 and cage 1802installed into the spine of a patient using a device according to anembodiment. Here, the vertebral cage 1802 is installed into anintervertebral space of a patient 2101, with screws 1803 inserted intoadjacent vertebrae 2002

FIG. 23 depicts a method for using a vertebral stabilization system inaccordance with an embodiment. The method begins by inserting apositioning handle 104 through a handle channel 1101 of the cage-plateholder 1101, 2302. Then, a surgeon can optionally attach a drill guideassembly to the cage-plate holder 2303. For embodiments where the drillguide assembly is permanently affixed to the cage-plate holder, thisstep 2303 can be omitted. Then the surgeon can insert the positioninghandle 104 into a vertebral stabilization plate 2304. This step mayfurther comprise the attachment of flanges or other interlocking devicesof the drill guide assembly 2001 and the cage 1802, as described above.Next, the distal end of the shaft of the positioning handle 501 can beinterlocked with the second locking mechanism 206 of the intervertebralcage 2001, 2305. Next, the intervertebral cage can be inserted into theintervertebral space of a patient 2306. Finally, a screw 1803 can beinserted through the opening of the drill guide assembly and into avertebra of a patient 2307. Following these steps, the interlockingmechanisms of the distal end of the shaft of the positioning handle andthe proximal end of the vertebral cage can be disconnected, freeing thevertebral cage plate from the cage-plate holder 1100 and drill guideassembly 1102.

While the present disclosure has been described in connection with aplurality of exemplary aspects, as illustrated in the various figuresand discussed above, it is understood that other similar aspects can beused or modifications and additions can be made to the described aspectsfor performing the same function of the present disclosure withoutdeviating therefrom. For example, in various aspects of the disclosure,methods and compositions were described according to aspects of thepresently disclosed subject matter. However, other equivalent methods orcomposition to these described aspects are also contemplated by theteachings herein. Therefore, the present disclosure should not belimited to any single aspect, but rather construed in breadth and scopein accordance with the appended claims.

What is claimed is:
 1. A vertebral stabilization system comprising: Apositioning handle comprising a shaft with a distal end and a proximalend, the distal end of the shaft comprising a first locking mechanism; acage-plate holder comprising a handle channel, the handle channel havingan inner diameter approximately equal to the outer diameter of thepositioning handle, such that a portion of the shaft can be insertedinto the handle channel; a drill guide assembly comprising an openingfrom proximal to distal end of the drill guide assembly, and wherein theopening of the drill guide assembly is configured to accept a drill; avertebral stabilization plate comprising a handle hole and an opening,wherein an inner diameter of the handle hole is approximately equal tothe outer diameter of the distal end of the shaft of the positioninghandle, such that distal end of the shaft of the positioning handle canbe inserted into the handle hole, and wherein the opening of the plateis substantially aligned with the placement of the opening of the drillguide assembly; and an intervertebral cage comprising a distal end, aproximal end, and an opening, wherein the proximal end comprises anorifice with a second locking mechanism configured to lock with thefirst locking mechanism of the distal end of the shaft of thepositioning handle, and wherein the opening of the cage extends from thesuperior side of the cage to the inferior side of the cage.
 2. Thesystem of claim 1, wherein the positioning handle further comprises afluid channel extending from the proximal to distal end of thepositioning handle.
 3. The system of claim 2, wherein the proximal endof the shaft of the positioning handle further comprises a syringereceptacle.
 4. The system of claim 3, wherein the proximal end of theshaft further comprises a feed ramp.
 5. The system of claim 1, whereinthe first locking mechanism of the shaft of the positioning handlecomprises external screw threads, and wherein the second lockingmechanism of the orifice of the cage comprises internal screw threads.6. The system of claim 1, wherein the first locking mechanism of theshaft of the positioning handle comprises a keyway, wherein the secondlocking mechanism of the orifice of the cage comprises a keyhole, andwherein the keyway is configured to lock in the keyhole.
 7. The systemof claim 1, wherein the cage-plate holder comprises a handle.
 8. Thesystem of claim 1, wherein the cage-plate holder further comprises saiddrill guide assembly.
 9. The system of claim 1, wherein the cage-plateholder further comprises a third interlocking mechanism, and the drillguide assembly further comprises a fourth interlocking mechanism, thethird and fourth interlocking mechanisms configured to interlock withone another.
 10. A method for stabilizing a vertebral column comprising:inserting a positioning handle through a handle channel of a cage-plateholder, the positioning handle comprising a shaft with a distal end anda proximal end, the distal end of the shaft comprising a first lockingmechanism; attaching a drill guide assembly to the cage-plate holder,the drill guide assembly comprising an opening from proximal to distalend of the drill guide assembly, and wherein the opening of the drillguide assembly is configured to accept a drill; inserting thepositioning handle into a vertebral stabilization plate, the platecomprising a handle hole and an opening, wherein an inner diameter ofthe handle hole is approximately equal to the outer diameter of thedistal end of the shaft of the positioning handle, such that distal endof the shaft of the positioning handle can be inserted into the handlehole, and wherein the opening of the positioning handle is substantiallyaligned with the placement of the opening of the drill guide assembly;and interlocking the first locking mechanism of the distal end of theshaft with a second locking mechanism of an intervertebral cage, thecage comprising a distal end, a proximal end, and an opening, whereinthe proximal end of the cage comprises an orifice with the secondlocking mechanism configured to lock with the first locking mechanism ofthe distal end of the shaft, and wherein the opening of the cage extendsfrom the superior side of the cage to the inferior side of the cage;inserting the intervertebral cage into the intervertebral space of apatient; and inserting a screw through the opening of the drill guideassembly.
 11. The method of claim 10, wherein the cage-plate holdercomprises said drill guide assembly.
 12. The method of claim 10, whereinthe drill guide assembly comprises a plurality of openings, wherein theintervertebral stabilization plate comprises a plurality of openings,wherein the openings of the plate are aligned with the location of theopenings of the drill guide assembly, and wherein a screw is insertedinto an opening of the drill guide assembly and into an opening of theplate.
 13. The method of claim 10, wherein the first locking mechanismof the shaft of the positioning handle comprises external screw threads,and wherein the second locking mechanism of the orifice of the cagecomprises internal screw threads.
 14. The method of claim 10, whereinthe first locking mechanism of the shaft comprises external screwthreads, wherein the handle hole of the vertebral stabilization platecomprises internal screw threads, wherein the second locking mechanismof the intervertebral comprises internal screw threads, wherein thefirst locking mechanism of the shaft is threaded into the handle hole ofthe plate, and wherein the first locking mechanism of the shaftpositioning handle is threaded into the second locking mechanism of thecage.
 15. The method of claim 10, wherein the first locking mechanism ofthe shaft of the positioning handle comprises a keyway, wherein thesecond locking mechanism of the orifice of the cage comprises a keyhole,and wherein the keyway is configured to lock in the keyhole.
 16. Themethod of claim 10 further comprising: disposing a material within theopening of the cage prior to disposing the cage into the patient. 17.The method of claim 10 further comprising: removing the first lockingmechanism of the shaft from the orifice of the cage; inserting a syringeinto the orifice of the cage, wherein the orifice of the cage extendsinto the opening of the cage; delivering fluid into the orifice of thecage and into the opening of the cage.
 18. The method of claim 10,wherein the positioning handle further comprises a fluid channelextending from the proximal end of the shaft to the distal end of theshaft, wherein the orifice of the cage extends into the opening of thecage, and wherein the proximal end of the shaft comprises a syringereceptacle configured to accept a syringe.
 19. The method of claim 18further comprising: inserting a syringe into the syringe receptacle ofthe shaft; and delivering fluid through the positioning handle, throughthe orifice of the cage, and into the opening of the cage.
 20. Themethod of claim 18 further comprising: disposing a material within theopening of the cage prior to disposing the cage into the patient;inserting a syringe into the syringe receptacle of the shaft; anddelivering fluid through the positioning handle, through the orifice ofthe cage, and into the opening of the cage.
 21. The method of claim 18,wherein the proximal end of the shaft further comprises a feed ramp.